Spinal Cord Stimulators

03/09/2013 — Nancy Sajben MD

For some reason my two browsers do not show the comments sent to this post, below, and therefore I am posting them now. I would emphasize the last comment by a very experienced nurse who has seen many complications of spinal cord stimulators. For persons with CRPS/RSD, I have seen many others. The saddest are those who had stimulators inserted and now the pain of CRPS is worst at the site of the “stim.” If the leads are ripped out from under the skin, the track of those leads may forever be the worst pain on the body.

Robyn H Says:08/04/2010 at 8:16 amI broke my hip and wrist during a fall at a local skating rink in my hometown in Georgia. The hip healed fine after surgery and two weeks later, surgery was performed on my right wrist. Immediately after surgery, the pain was different. I was soon diagnosed with RSD and put on several medications and therapy three times a week. After many weeks of oxycontin, oxycodone, neurotin, topamax, klonopin, robaxin and paxil and four nerve blocks (SGB), it was suggested I receive the spinal cord stimulator. Through research on the internet, I found Jim Broatch with the RSDSA organizaton who advised me there were other alternatives in treating RSD. I discovered Dr. Nancy Sajben in San Diego. She has been treating RSD with oral ketamine and naltrexone. I saw Dr. Sajben in her office July 19th and began treatment. Since beginning treatment, I have been able to go off the opiods and have had a 70% improvement in my range of movement of fingers and arm and decreased pain levels to the extent that I can now tolerate physical therapy. I have had no “flare ups” since beginning treatment. Dr. Sajben has changed my life for the better and given me hope for the future. Thank you, Dr. Sajben!

Nancy Sajben MD Says:08/04/2010 at 6:00 pmRemarkably, in one and one-half days, she no longer needed high dose oxycodone which she decreased 95% on her own as pain was 40% better. That was before ketamine reached a dose where it began to have an effect and before naltrexone was prescribed. The later addition of those two helped even more. By the start of week two, she was able to discontinue the last 5% of oxycodone and is 70% better off opioids. She was started on a few other medications than mentioned in her comments: rational polypharmacy. Since January, she was unable to move her fingers, unable to write or pick up anything with the right hand. Less than ten days after we started treatment, the fingers had regained modest motion. She could hold a pen, write, pick things up with the fingers, fold laundry, pack luggage, and best of all her seven year old daughter said: “Mommy, I can hold your hand for real now.” Allodynia and hypersensitivity of the hand is so much better that she is likely to be able now to make progress in physical and occupational therapy. It was too painful prior to her visit. There has not been one flare of CRPS since day one on July 19, 2010, despite using the hand in ways not possible for seven months.

Lori Morris Says:01/11/2011 at 6:45 pmI would first like to thank you for your specialization in CRPS. My husband was diagnosed with CRPS in March 2010. He suffers in his lower left extremity (left foot/ankle) with all the signs of CRPS. He has gone through extensive pain management since that time. He has used oral meds, morphine, oxycontin, and now methadone, and also takes lyrica and nortriptylene along with lortab as needed. He has had no relief with these meds. He has had one nerve block with no relief, so a second block was not attempted. On Friday Jan. 7th the SCS trial was done and today Jan. 10th removed due to it causing pain in his lower back and side. The jolting the SCS caused in these areas could not be over come with reprogramming the SCS. Today, his pain management doctor discussed the Drug Delivery Therapy, which is not crazy about doing and after reading your information regarding SCS and Pumps I too am having second thoughts. However, the doctor did mention that there were 2 clinics that specialized in CRPS. One at John Hopkins and the other at UCLA. His doctor recommends the UCLA clinic and that is how I got to your page. I have been doing my research on CRPS since my husband was first diagnosed and am always looking for anything new in the medical field. I have read all your information regarding the Ketamine and Naltroxene treatments your patients have received and will be discussing these with his local pain management doctor. So, again I just want to thank you in advance for your specialization and your web page. Who knows, we just may meet some day.

Nancy Sajben MD Says:01/15/2011 at 6:17 pmCRPS is unlike any other pain syndrome because it can be spontaneous or triggered by something very slight. Pain can involve the entire body. There is a high incidence of suicide. Despite that, there is a hope that it may be entirely reversible or, at least, put into remission. What a joy to see that happen and to share in the recovery!!!

Traci Says:03/29/2011 at 6:01 amI posted on your main blog, but haven’t heard back. I know you wanted information regarding issues or problems with Spinal Cord Stimulators, so here is some information that you can add to your file. I can also be contacted for additional information because this issue continue to date.

In one of your posts you asked for input from patients that currently have a SCS. I currently have a Medtronic SCS it was implanted early 2010 and I ended up having swelling in my Lt (affected) foot/ankle every time I would charge the “re-chargeable battery”. No one at Medtronic could figure out the issue. I turned into their “human lab rat”. After several months of this I was told to switch from a rechargeable battery to a non-rechargeable batter. Thus another operation… which I did. After this surgery (I have a paddle with 16 electrodes) all 8 electrodes on the Lt side that used to supply stimulation to my Lt foot/ankle now hit my pelvic area – thus I can no longer utilize these electrodes. And out of the 8 electrodes on the Rt 2 are providing stimulation to my Lt foot and the other 6 are hitting the wrong areas. In addition to this I have had continual instances where I am getting a very sharp pain/ sharp twinge (like a jolt) around where the electrodes area. When this happens if I turn off the SCS the pain immediately stops. I’ve been on a conference call with a Senior Engineer of Medtronic and a local Rep in person with me to do reprogramming… The Engineer only wanted to know if the electrodes were putting out stimulation. He didn’t want to know what the amperage was at before I could feel it or in what part of the body the stimulation was felt. These should have been critical pieces of information. All he wanted to state was that the electrodes were working. As for the Sharp Pain / Sharp Twinges that continue to occur in the electrode area their Senior Engineer has no idea what is causing this. He asked me to run an experiment the next time it happened – I did exactly what he wanted and reported back the findings. I have yet to hear back from Medtronic. They do not want to back up their product and they are not willing to admit that their is a problem. Although I have 2 doctors including a Neurosurgeon that feel there is some type of fault in their product or that it is faulty. Hopefully this gives you some additional information you were seeking. Please feel free to email me if you would like to discuss further. I am continuing my uphill battle with Medtronic.

I have spoke with Medtronic as recently as yesterday and they can not explain the continual sharp pain/sharp twinge that I continue to get where the paddle that holds the electrodes is placed. The “Patient Relations Rep” that has been assigned to me, (at one point she tried to tell me she was from their “Legal Department” and she was later introduced by a team member as a “Patient Relations Representative”), doesn’t feel this is a big issue. She told me yesterday that this is “just medicine” and sometime they can get it right and other times it just doesn’t work out… The Senior Engineer at their company can not figure out what the problem is, so he just wants to reset the “INS”. I asked exactly what the “INS” was and the Patient Relations Rep couldn’t answer that question. I have already had my system reset numerous times (too many to count) and reprogrammed numerous times.

The trial was aproximately $25,000; the hospital expenses alone and cost for the SCS implant were over $150,000 and the secondary surgery to replace the rechargeable battery with a non-rechargeable battery was aproximately $53,000. This is all for a system the now has 2 out of 16 electrodes that hit the correct area, creates an intermitent sharp pain/sharp twinge in the spinal area where the electrodes/paddle is placed, and they aren’t sure how to resolve this issue. But I was told yesterday that their system was working properly by their rep.

Nancy Sajben MD Says:04/01/2011 at 2:48 amTraci, thank you for your comments and for placing your second comment in this section where others with CRPS may be more likely to see it.

One of the simplest ways to respond to the issues you pose is to say that a renowned pain specialist colleague, trained in Anesthesia Pain at Harvard 40 years ago, does not put in spinal cord stimulators, does not recommend them and does not refer patients for them. He trained in how to use them when they came out, just as he trained for morphine pumps. He has never placed either in a patient.

The common sense question is: Show us the data. Five year long term data with complications. Invasive procedures do have potential risks.

The body tissue of a person with CRPS is very volatile, very different than any other condition I know. Any surgery, any procedure in that person is a risk not to be taken lightly. Just a needle stick for blood draw or vaccine can trigger CRPS.

There is no question it is a big money maker. Several can be placed in many patients in a few hours. In no time at all, it has become an industry. And that kind of wealth can control the way pain management is practiced in this country. It doesn’t pay to do anything else. NIH doesn’t try. Show us the research.

Nothing interests me more than the neuropharmacology approach I use for CRPS and “intractable” pain from the many conditions my patients have. I wish you lived nearby.

Maureen Says:01/22/2012 at 5:57 amI just had the scs implanted two weeks ago. I am getting that sharp pain and burning near the battery site. It happens with the scs on or off. I really am wishing I never got it. I feel that the small relief that I am getting is not worth it. Are you telling me that the leads can never come out and no MRI ever? I do believe they can be removed.

Nancy Sajben MD Says:01/24/2012 at 4:41 pmI believe they can be removed, but they may become tethered to the spinal cord itself. I presume that may occur when they have been in for some time. I do not implant these, but one of the foremost anesthesiology pain specialist in the country, Harvard trained in pain management, will not put these in and will not refer patients for them.

Barb Fosdick Says:06/07/2012 at 11:25 pmeditI have been a surgerical nurse for 40 years and have seen many patients receive SCS…and many, many fail, or return to surgery for fractured electrode wires, misplaced wires, or infected battery pockets, besides complicated problems, or “lack of positive results, or battery revisions, or electrode repositionings.” Some patients have even developed spinal fluid leaks when the spinal dura layer has been torn during implanting the electrode wires, and they develop severe headaches, and have to return to surgery for the leak to be repaired. Many pain management doctors are convincing patients that this is a great way to treat their pain, and they find out in 2-6 months that they wish they never had agreed to it. Sure, there are some patients that get some relief, but this procedure has been pushed on the population of chronic pain patients, when they are at their worse condition, and willing to try anything….at any expense, and the companies and implanting doctors are getting the money. More patients need to learn the truth about these devices! Anomymous…. and never allowed them to put one of those things in me…but many tried!